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General NPI Number Information
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NPI Number | 1114056579
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Entity Type | Organization
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Legal Business Name | SOUTH BROWARD MRI CENTER, LTD
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Dates
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Enumeration Date | 03/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3500 HOLLYWOOD BLVD
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City | HOLLYWOOD
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State | FL
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Zip | 33021-6809
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Country | US
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Telephone | 954-983-6488
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Fax |
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Provider Business Mailing Address
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Address Line | 3500 HOLLYWOOD BLVD
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City | HOLLYWOOD
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State | FL
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Zip | 33021-6809
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Country | US
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Telephone | 954-983-6488
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | HERBERT LOUIS SHICK
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Credential | MD
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Telephone | 954-962-4700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State | FL
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